Olaolu Olusina
12 January 2009
Lagos — Two years after the National School Health Policy was formulated, the document is still being kept on the shelf at the Federal Ministry of Education in Abuja. Interestingly, a private sector initiative is rising to the challenge by pioneering the healthcare services which combine preventive, promotive and curative to complement the learning process of children, writes Olaolu Olusina
One of the objectives of the National School Health Policy is to promote the health of learners to achieve the goals of Education for All (EFA). However, the findings of a rapid assessment of the School Health System in Nigeria, carried out in 2003, by the Federal Ministry of Education, in collaboration with the Federal Ministry of Health, United Nations Children Fund (UNICEF) and the World Health Organisation (WHO) are quite shocking.
The report of the survey which was released in November 2006 showed among others, that 14 per cent of head teachers indicated that pre-medical examinations was mandatory in their school; 17 per cent have school nurses; 20 per cent of pupils do not have normal visual acuity; about 20 per cent have subnormal hearing; dental plague was observed in more than 10 per cent of students; while only six per cent have linkages with government-designed/approved clinics.
The report also listed five common health problems of students that contribute to absenteeism as fever/typhoid (56 per cent); headache (43 per cent); stomach ache (29 per cent); cough/catarrh (38 per cent) and malaria (40 per cent). While the statistics are clear pointers to the pathetic state of school health in Nigeria, calling for urgent intervention, the problem at hand is better understood by the stand of UNESCO on the issue.
In underscoring the importance of the health of the pupils to their ability to cope well in school, UNESCO had stated that the "health problems interfere with students' ability to come to school, or to make the most of their opportunity to learn." The world body therefore suggested that "schools, even those with limited resources, can do a great deal to improve student health and thus educational outcomes."
It was in response to this clarion call that several global school health initiatives were floated to independently, and collaboratively, advocate and implement integrated school health programmes. Some of these initiatives include, but are not limited to, the WHO 1995 Health Promoting Schools Initiative; UNICEF's Child-Friendly Initiative as well as the Child-to-Child Trust for promoting children's participation in health and development.
It is however unfortunate that none of these initiatives has had much impact on the general well-being of the Nigerian child. Aside the reason adduced by UNESCO, many other justifications has been adduced by experts to support the need for a comprehensive school health programme. The fact that school kids spend most of their wake time in school, and health conditions are often first detected while at school, readily lend credence to the need for an integrated school health programme.
Most parents are also too busy and would want to be assured that there is a health system that caters for their children or wards while in school so that they can concentrate on their businesses. Just because children learn more by observation and practice, a school health programme brings healthcare closer to the children whose fast growth sometimes mean changing the healthcare needs.
Given the fact that teenage myopia averages 20 per cent globally and could be as high as 73 per cent as was seen in a study of two secondary schools in Singapore, both unnecessary and permanent disabilities are often first detected while they would be avoided through a comprehensive school health programme.
The school health programme therefore enables the school to have relevant health data of the pupils and monitor their health by carrying out regular examinations such as post-resumption and pre-vacation medical tests for both returning as well as fresh students. On the whole, an integrated school health programme makes the school milieu safer and more ideal for learning just as it confers a competitive advantage on the school.
Despite the benefits, however, the Nigerian government has continued to show a lackluster attitude to the implementation of the National School Health Policy. This, of course, has now opened a window of opportunities to discerning private investors to eventually go into a public-private partnership with government to address this issue of national importance.
The first of such private initiatives, and in fact , the only one at the moment in the country, is the Medfield School Health Programme (MSHP) which is blazing the trail by providing healthcare services that combine preventive, promotive and curative care to complement learning process in Nigerian schools.
Starting out in Lagos, the MSHP, which actually aligns itself with the National School Health Policy 2006, combines the establishment and management of sick bays (in-house clinics), preventive and screening programmes with provision of basic healthcare at accredited clinics and hospitals close to the schools with a system of referral and coordination.
Managing Director/Chief Executive Officer, Medifield Healthcare Limited, Dr. Adewale Owolabi, who is also the first Nigerian to be certified in Healthcare Quality Management by the American Healthcare Quality Management Board, said the MSHP was conceived to fill a gap in the country's health sector.
Medifield has a number of healthcare services being offered to Nigerians, but the Medifield School Health Programme (MSHP) is new. "We are blazing the trail and through it, we are bringing quality healthcare to Nigerian schools through a private initiative," he told THISDAY recently. He however distinguishes between the two variants of the programmes. "The first is the Medifield Comprehensive School Health Programme (MCSHP) which combines the establishment and management of sick bays (in-house clinics), prevention and screening programmes with provision of basic healthcare at accredited clinics and hospitals close to the school with a system of referral and coordination. The second, according to him, is the preventive and screening School Health Programme (PSSHP), which provides detailed disease prevention, health promotion and screenings without the establishment and running of the school sick bay," he said.
Disclosing the triggers that eventually led to the conception of the idea which, according to him, is the only one currently in Nigeria, Owolabi said, "early 2007, I traveled to the United States of America and I saw the school health system at work and remembered that when we were growing up, we used to have sick bays and clinics situated close to our schools."
Stressing that he observed that such clinics and medical outposts no longer exist in Nigeria, he disclosed that "we then spotted the needs and gaps in the healthcare industry and we aimed at filling these gaps." Owolabi said as he and his colleagues at Medifield were busy brainstorming on the best way to approach the new opportunity and address the need, "we came across a National School Health Policy which was signed by the former Minister of Education, Dr. Oby Ezekwesili, and we discovered that most of the things we intended doing in our school health services are actually part of this policy document."
According to him, "we now sought for further alignment and discovered the global initiatives by WHO (1995) when it came up with criteria for designating schools as health-promoting schools," adding "we also came across the UNICEF Child Friendly Initiatives and the UNESCO FRESH Initiative as well as many others that align with what we are doing."
Finding enough reasons to give a private sector boost to the national policy in limbo, the Medifield boss further said: "That was gratifying to us as what we saw as a need is what the international community and organisations are advocating. We also found alignment with the Lagos State efforts to revamp school health through the provision of Mobile (Dental) Oral Health Clinics and also making health services free for children and the old people."
Owolabi said the MSHP revolves around six components, namely screening services (eyes and ear), basic health services, referral services, deworming programme, growth monitoring and skill-based health education. He said that Medifield normally sets up a child-friendly sick bay at the school where this does not exist previously or upgrade an existing one.The set up or upgrade, he disclosed, covers equipment, infrastructure and systems. "We also match the scope with the service components as well as with the number of pupils served."
He also said the sick bays are staffed by at least one registered staff nurse, depending on the number of pupils served, adding that Medifield provides training and retraining for the school health nurses in addition to their basic nursing training. Owolabi however disclosed that conditions outside the scope of the sick bay are referred to accredited hospitals close to the school.
"The hospitals are chosen based on service capabilities and with the approval of the Parents Teachers' Association (PTA) and the school authority. Treatment consents are obtained and feedback provided to the school, the parents and the pupils' record at the sick bay.
"In working with private schools, we utilise the principle of resource pooling in which a small amount is paid per term, usually between N500 and N2, 000 depending on the school population, and the chosen variant of our programme. This approach enables us to deliver equitable quality service which encompasses screening and preventive, curative and educative, to everyone at a price they can afford," he explained
On the difference between the programme and the National Health Insurance Scheme (NHIS), Owolabi told THISDAY that "it is not a duplication of NHIS as NHIS provides comprehensive healthcare for families through the payment of premium, but doesn't include key components of our school health services such as the sight, dental, hearing screening, deworming and monitoring of the children's growth."
Buttressing the need for an integrated and working school health programme, Owolabi painted a pathetic picture as he lamented that one in every five Nigerian students has poor sight. "That is bad as it explains why 13 per cent of those that write the last West African Examination Council (WAEC) examination had over three credits. Educational instructions are passed through audio-visual means," he said. "In a situation where 19 per cent of school children have sub-normal hearing, 10 per cent have dental plaques, and only six per cent have linkages with hospitals. When you put these together, some can't see, some can't hear and so, you can have some 30 per cent or more with deficiencies in their ability to see and hear. You then begin to see where the problem with our education sector lies."
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